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The Fight for Better Care for Pregnant Women in Texas Jails

Shela Williams, a 29-year-old mother living in Austin, was incarcerated when she was 18 weeks pregnant with her second son, Israel. Williams was seeing a specialist before she went to the Travis County Jail because Israel had spina bifida and the pregnancy was high-risk.

Williams told the Current that although she told the jail's medical staff about her condition when she was booked, they didn't schedule an appointment with a physician until weeks later. At 24 weeks, a doctor told Williams that her baby "wasn't going to make it," she said, remembering feeling uncomfortable and disrespected throughout the exam. A few weeks later, she was induced at an Austin hospital, more than two months before her due date. She gave birth with the help of a midwife while a jail guard watched from the corner of the hospital room. Israel wasn't breathing when he was born. She spent one night holding her baby, then returned to jail while her family planned and held Israel's funeral.

"That's really stressful for [family] to plan a funeral by themselves because they were expecting Israel to make it ... I'm blessed that my family was so strong," she told the Current. "Never in a million years did I think I wasn't going to get to go ... but I get through it, I go to his grave."

Williams carries a pale yellow box with a butterfly on top that contains the few photos she has of her son. She shares her story in the hope that it will raise awareness in the fight for better health care for pregnant women in Texas jails.

A coalition of organizations, including the Texas Jail Project, Austin-based Mama Sana/Vibrant Woman Pregnancy and Women's Clinic for women of color, Amnesty International and Moms Rising is calling on the Texas Commission on Jail Standards to implement more robust, detailed policies and procedures to ensure pregnant women get proper obstetric, prenatal and postpartum care while they're incarcerated in Texas county jails. The coalition argues that, with more than 200 county jails statewide, the commission's minimum standards aren't strong enough, nor are county jails held accountable if appropriate care isn't available, creating a dangerous situation for expectant inmates.

Kellee Coleman, Williams' friend and a birth companion with Mama Sana, was also incarcerated while she was pregnant. She shared Williams' experience with the Texas Commission on Jail Standards at a November 6 public hearing in Austin.

"Everyone deserves adequate care no matter where they are; babies don't have to die," Coleman said.

Diana Claitor with the Texas Jail Project has heard from hundreds of Texas women and their families about the inadequate medical care they've received while incarcerated. According the Sentencing Project's analysis of 2010 Bureau of Justice Statistics data, more than 205,000 women nationwide are incarcerated in federal prisons, state prisons and local jails, a number that has increased every five years since the 1980s. The data show women are more likely than men to be behind bars for nonviolent drug or property crimes.

According to the Texas Commission on Jail Standards, on October 1 of this year, 527 pregnant women were incarcerated in Texas county jails. The monthly average, Claitor says, hovers between 400 and 500.

"Most jails and prisons are built by men for men, and so as the increase of incarcerated women has occurred, a lot of these problems are having to be worked out," Claitor said at the November 6 hearing. "The needs of pregnant inmates are very important to the families and those children."

A state law passed in 2009 required the commission to adopt a framework of "reasonable" standards for county jails to determine if a female inmate is pregnant, and ensure that county jail health services plans, which are submitted to the commission for approval every five years or so, address the medical care, mental health, housing and nutritional needs of pregnant inmates. In 2012, the commission required county jails to add general language to their health services plan.

Diana Spiller is with the Texas Commission on Jail Standards. She said the agency doesn't outline specific services or standards of care because resources and availability of medical providers varies across the state. Larger jails in urban counties likely have more medical personnel available to treat and care for pregnant inmates, she said, while more rural counties may not even have an obstetrics specialist in the area.

"I think one of the complaints about our current standards is that they're too vague or too general," she said. "If we mandated specific treatment or protocol that might be setting [smaller, rural counties] up for failure and they cannot comply ... that's where we're trying to juggle."